Transcatheter Aortic Valve Replacement: Everything You Need to Know

Minimally invasive treatment for aortic stenosis

In This Article

Transcatheter aortic valve replacement (TAVR) is a minimally invasive surgery in which the aortic valve in the heart is replaced with an artificial valve. The procedure is done when the aortic valve doesn't function as it should. When there is a high risk of surgical complications, TAVR is a less invasive alternative to the traditional open-heart surgery method of replacing a heart valve, and it is also becoming an option for people who don't have an exceptionally high risk of complications. However, even though it is minimally invasive, TAVR is a major procedure that has risks.

What Is Transcatheter Aortic Valve Replacement

A transcatheter procedure is a type of surgery that relies on a small incision in the skin to thread a catheter (small tube) through a blood vessel to reach the surgical destination. An aortic valve replacement involves the implantation of an expandable artificial valve made of metal and animal tissue into the heart.

If you have a TAVR, your artificial aortic valve would be inserted into its position after your surgeon advances it through a catheter to the aorta. Sometimes the procedure is called transcatheter aortic valve implantation (TAVI).

The aorta, emerging directly from the heart, is the largest artery in the body and its branches carry oxygenated blood from the heart to the rest of the body. The aortic valve, composed of several cusps of tissue, is located between the heart and the aorta and helps control blood flow from the heart to the aorta.

An interventional cardiologist or a heart surgeon would perform your TAVC. Your incision will be either in your groin with monitored anesthesia sedation and local anesthesia or in your chest under general anesthesia.

Contraindications

You might not be a candidate for TAVR if your health is very unstable or if you have mild aortic valve disease.

Generally, recovery after a TAVR is faster than recovery after an open aortic valve replacement, but you can have a high risk of surgical complications or death if you have organ failure (such as kidney failure or pulmonary failure). This high risk could make your surgery more risky than beneficial for you. Additionally, if you have a life expectancy of less than a year, such as due to end-stage cancer, this surgery could increase your risk of death.

And your health insurance payer might not approve this minimally invasive method of valve replacement if you have mild aortic disease or a low risk of surgical complications. The guidelines regarding the indications for selecting this procedure instead of an open aortic valve replacement are changing.

Potential Risks

The risks of TAVR surgery include the risks of general anesthesia and surgery. Additionally, there are specific complications that can develop as a result of TAVR.

Complications include:

  • Postoperative stroke
  • Heart attack
  • Blood clots
  • Bleeding at the incision site
  • An infection at the incision site
  • An injury to the heart during the procedure
  • Arrhythmia (irregular heart rhythm)
  • Endocarditis (infection of the valve)

Complications after heart surgery can be serious and may be life-threatening. You will have close monitoring in the hospital for the first day after your operation so your doctors can identify signs of problems at an early stage.

Purpose of Transcatheter Aortic Valve Replacement

When the aortic valve is damaged due to calcification, its cusps do not move the way they should. This can cause aortic regurgitation, which is leakiness of the blood as it travels through the aorta and/or aortic stenosis (narrowing of the aorta).

Aortic valve disease is common and typically develops with age. It can cause fatigue, exercise intolerance, syncope (episodes of fainting), chest pain, and congestive heart failure. The condition can become so severe that it is life-threatening if left untreated.

Repair or replacement of the aortic valve can alleviate symptoms of aortic valve disease and may prolong life, A TAVR is done to replace—not repair—a damaged aortic heart valve.

As you are discussing your treatment options with your doctor, TAVR surgery may be considered as an option for an aortic valve replacement without the physical stress of open-heart surgery and cardiopulmonary bypass. Recovery is usually faster, but the risk of surgical complications is the same.

How to Prepare

Before having a TAVR, you will have an assessment of your aortic valve. Your surgeon will likely observe the function of your heart and the structure and motion of your aortic valve with an echocardiogram. Measurements of the valve and the aorta will be taken in preparation for your surgery. Additionally, you will have an ultrasound test to assess the size and patency of blood vessels that will be accessed during your surgery.

Your pre-operative testing will include a complete blood count (CBC), blood chemistry tests, chest X-ray, and electrocardiogram (EKG).

Location

You will go to your surgery from home, and you will spend at least one night in the hospital after your operation. Your procedure will be done in a hospital operating room or procedural suite.

What to Wear

You can wear anything comfortable to your surgery appointment. You will have to wear a hospital gown during your procedure.

Food and Drink

If you are having general anesthesia, you need to fast from food and drink after midnight the night before your surgery.

If you are having monitored anesthesia sedation, you will not have to adjust your food and drink in preparation for your surgery.

Medications

Your doctor will instruct you about whether you should adjust the dose of any blood thinners or medications that you take for treating heart disease.

What to Bring

When you go to your surgery appointment, you need to bring your identification and insurance information. If you will be paying for a portion of your surgery, you should bring a form of payment.

You will likely stay overnight in the hospital for at least one night after your surgery. You should have someone who can drive you home when you are discharged from the hospital.

Pre-Op Lifestyle Changes

Smoking can interfere with recovery, and your doctor may talk to you about smoking cessation prior to your surgery.

What to Expect on the Day of Surgery

When you go for your surgery, you will have to register and sign a consent form.

You will go to a pre-operative area, where you will change into a hospital gown and have an intravenous (IV, in a vein) line placed in your hand or arm.

You will have your temperature, blood pressure, pulse, respiratory rate, and oxygen saturation checked. Your oxygen saturation is monitored with a non-invasive pulse oximeter that is placed on your finger.

You may have same-day tests, including CBC, blood chemistry, and urinalysis. You may have a urinary catheter placed before you go to the operating room or after you get there.

Before the Surgery

When you go to the operating room, you will have your skin prepared for the incision, your anesthesia will be started, and your urinary catheter will be placed if it hasn't been already.

Your body will be covered with a surgical drape and the area of skin where you will have your incision will be exposed and cleansed. Your incision may be in your groin or in your chest.

Your anesthesia will be started as the medication is injected into your IV. For general anesthesia, the medication will put you to sleep and you will have a breathing tube placed in your throat for breathing assistance during surgery.

For monitored anesthesia sedation, you will have anesthetic medication injected in your IV to make you drowsy, and local anesthesia will be placed in the skin near the incision site.

During the Surgery

Your surgeon will begin your surgery by making a small incision, less than an inch in length. Your incision may be placed in your groin to access your femoral artery or in between your ribs to access your subclavian artery.

The catheter is placed into the artery through the skin incision. With imaging guidance, the catheter is advanced through the blood vessels until it reaches the aortic valve.

As the catheter is moved through the blood vessels, the artificial valve is bundled into a tiny package that is small enough to be moved through the blood vessel along with the catheter. When in place, the valve replacement is deployed, opening to its full size. 

Usually, the replacement valve is placed over the original diseased aortic valve so it can take over the function of controlling the release of blood from the heart.

After the replacement valve is properly positioned, your surgeon will observe its function using imaging studies. If the placement is correct and the valve is functioning properly, the catheter will be removed. If any adjustment is needed, that will be done before your catheter is removed.

The blood vessel and skin incision will each be closed with suture, and your skin will be covered with a surgical dressing.

Anesthesia is stopped or reversed. And if you have had a breathing tube during your surgery, it will be removed, and your anesthesia team will ensure that you are breathing comfortably on your own.

After the Surgery

In the recovery area, you will begin to wake up. You may feel a little groggy. Your medical team in the recovery area will help you walk and will give you medication for pain as needed.

You will likely have a plan to stay in the hospital overnight or for a few days after your surgery. During your hospital stay, your heart function will be monitored with an EKG, and your oxygen saturation will be monitored with pulse oximetry. Your blood pressure, pulse, and respiratory rate will be monitored as well.

Your surgical wound will be checked and your medical team will explain how you should take care of it at home. After one day or a few days, you will be discharged to go home.

You may have some of your heart medications, like your blood pressure medication, adjusted. And you will be getting blood thinner medication while you're in the hospital, as well as a prescription for blood thinner medication to prevent blood clots. You may also have a prescription for pain medication to take at home.

You will have instructions about when to make your follow-up appointments, and signs of any complications you should look out for.

Recovery

You should feel comfortable as you are recovering after your valve replacement. You may begin to feel more energetic than you did prior to your surgery within days of your procedure.

During your follow-up appointments with your doctor, your wound will be examined, sutures removed, and your heart function will be evaluated as well.

Because a TAVR involves a small incision, it should heal within about a week. If you have developed heart disease, such as heart failure, prior to having your valve replacement, your doctor may recommend that you begin cardiac rehabilitation.

Healing

In your first few days home after your surgery, you can take pain medication as directed. You will need to get up and walk around to avoid complications like blood clots. Your doctor may even prescribe a target number of steps for you to take.

You will need to keep your wound clean and dry as it is healing. If you have mild swelling, you can use an ice pack to reduce the swelling. Don't place the ice pack directly on your skin.

Signs of complications to look out for include:

  • Fever
  • Pain, bleeding, pus, or severe swelling near the incision
  • Chest pain
  • Shortness of breath
  • Dizziness
  • Fainting
  • Palpitations (a sense that you have a rapid or irregular heart rate)

Call your doctor's office if you start to experience any of these issues.

Coping With Recovery

As you are recovering, you may need to adjust to taking new medications. Blood thinners can make you prone to bleeding, so you have to be careful about avoiding falls.

You may also be taking new medications or different doses of your previous medications for the treatment of heart failure or hypertension. Be sure to stay in touch with your doctor if you experience any side effects of these treatments, such as lightheadedness, shortness of breath, fatigue, or palpitations.

Long Term Care

You will need to remain on blood thinner medication as directed by your doctor for as long as you have your valve in place.

And you will need periodic monitoring of your heart function, which can include an EKG and an echocardiogram.

After a heart valve replacement, you can be at risk of developing endocarditis after dental work. You should tell your dentist about your artificial heart valve, and you may need to take antibiotics before having dental work to prevent an infection.

Possible Future Surgeries

In general, an artificial aortic valve might not last forever. Depending on the valve that you have, you may need a replacement after 10 or 15 years.

Although a valve can last for your whole lifetime—even if you have a long life expectancy, you and your doctor will have to discuss whether you would want another surgery if your valve starts to fail. If your valve begins to lose optimal function, you may develop symptoms of aortic valve disease.

You can develop another heart disease that requires surgery after your TAVR. Many times, the same risk factors that led to aortic valve disease can lead to other heart problems, such as coronary artery disease or cardiac arrythmia.

Lifestyle Adjustments

Overall, you should feel better after your TAVR than you did before the surgery. The most important adjustment you have to consider is the risk of bleeding due to blood thinners. You may have already been taking blood thinners for years prior to your TAVR surgery, so this may not necessarily be a change for you.

The risk of bleeding means that you need to avoid activities that could cause major falls, such as hiking or climbing on an irregular surface. And you may even need to be extra careful when biking or walking up and down the stairs, especially if you don't have a good balance.

A Word From Verywell

Having a minimally invasive aortic valve replacement can improve symptoms of aortic valve disease and can prevent death due to this disease. The surgery would give you a faster recovery time than open-heart valve replacement. But because a TAVR is a type of heart surgery, advance surgical planning is a major part of the process and there is a risk of surgical and post-surgical complications that you need to consider when thinking about having this operation.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cubero-Gallego H, Dam C, Meca J, Avanzas P. Transcatheter aortic valve replacement (TAVR): expanding indications to low-risk patients. Ann Transl Med. 2020 Aug;8(15):960. doi: 10.21037/atm.2020.03.155. PMID: 32953760; PMCID: PMC7475389.

  2. Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther. 2020 Sep 23:1-16. doi: 10.1080/14779072.2020.1792777. Epub ahead of print. PMID: 32791869.

  3. American College of Cardiology. ACC expert consensus on TAVR for adults with aortic stenosis. January 24, 2017.

  4. Prendergast BD, Redwood SR. Transcatheter aortic valve replacement. Circulation. 2019 Jun 11;139(24):2724-2727. doi: 10.1161/CIRCULATIONAHA.119.040016. Epub 2019 Jun 10. PMID: 31180746

  5. Winter MP, Bartko P, Hofer F, Zbiral M, Burger A, Ghanim B, Kastner J, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G. Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies. Sci Rep. 2020 Sep 23;10(1):15568. doi: 10.1038/s41598-020-72453-1. PMID: 32968104.

  6. American Heart Association. Transcatheter aortic valve replacement (TAVR).

  7. Moriyama N, Lehtola H, Miyashita H, Piuhola J, Niemelä M, Laine M. Hemodynamic comparison of transcatheter aortic valve replacement with the SAPIEN 3 Ultra versus SAPIEN 3: The HomoSAPIEN registry. Catheter Cardiovasc Interv. 2020 Sep 23. doi: 10.1002/ccd.29281